Institute for Life Course and Aging 2016-2017 Seminars & Workshops “Understanding Elder Mistreatment: What Do We Know?” David Burnes, B.Sc., M.S.W., P.hD Assistant Professor, University of Toronto Factor-Inwentash Faculty of Social Work Affiliate Scientist, Baycrest, Rotman Research Institute http://socialwork.utoronto.ca/profiles/david-burnes/ david.burnes@utoronto.ca
Presentation Overview Elder Mistreatment (EM) A. Population demographic backdrop B. Community-based EM C. EM in long-term care – resident-to- resident aggression
LCP Emergence 2) Changes in Population Composition • Age structure
Overall changing Structure of Population Age Demographics • Baby boomers Declining birth rates • Increased life expectancy •
Population Age Demographics Baby Boomer • A person born following WWII (1946 – 1964) Disproportionately high birth rate • This relatively large age cohort is now enter • later adulthood
Declining Birth Rates
Global Female Life Expectancy Can life expectancy keep going up? How high can it go?
Percentage Change in the World’s Population by Age: 2010-2050
Aging Population in Canada Population aged 65+ expected to double over next 25 years – 5M to 10.5M 9 Maclean’s, 2012 – Statistics Canada data
Ontario Population 65+ expected to double over next 25 years – 2M to 4.2M 10 Ontario Ministry of Finance, 2013
What does this mean for EM? Scope of EM will keep getting bigger, bigger, bigger
EM Typologies EM Institutional Settings Community
Community Elder Mistreatment An intentional act or omission occurring in a relationship of trust, which causes harm or serious risk of harm to a vulnerable older adult or deprives an older adult of basic needs. Emotional Physical Acts Neglect (Omission) Sexual Financial
Impaired capacity for self-care or self-protection (financial, physical, functional, mental, cognitive, emotional, etc.) Vulnerability A C Expectation of trust arises from law or EM social convention: - Family Older Age Relationship - Caregivers (paid) B - Friends/Neighbours of Trust - Professionals Blurred? A = Self-Neglect or B = … C = Mistreatment of Stranger-Perpetrated Adults with Disability Events (crime,scams)
What is the difference between domestic/intimate partner violence and EM? • In scenarios of long-term domestic violence, does domestic violence become EM simply because the victim becomes older than a designated age (e.g., 60 or 65)? • How do we draw the line between domestic violence and EM?
Impaired capacity for self-care or self-protection (financial, physical, functional, mental, cognitive, emotional, etc.) Vulnerability A C Expectation of trust arises from law or EM social convention: - Family Older Age Relationship - Caregivers (paid) B - Friends/Neighbours of Trust - Professionals Blurred? A = Self-Neglect or B = Domestic or Intimate C = Mistreatment of Stranger-Perpetrated Partner Violence Adults with Disability Events (crime,scams)
Difference between domestic/intimate partner violence and EM? If violence against a partner is initiated or becomes • more severe due to the older partner’s age- associated vulnerability, then it is properly characterized as EM • Conceptually, vulnerability (not age) is the determinative concept • But, in practice and research, age cut-off is typically age 60 or 65.
How Else is EM Different than DV/IPV • Types of mistreatment o EM includes neglect and financial exploitation • Types of perpetrators o EM is much broader – includes perpetrators in any relationships of trust including children, neighbors, professionals, etc.
Frequency • Confusion/inconsistency both conceptually and in research • Should single acts be included and for what types of EM? Move field towards greater clarity and • conceptual rationale (e.g., WHO report)
What do we know about EM in the community?
Consequences/Costs Individual • Mortality (3X) • Psychological distress (e.g., anxiety, depression) • Poor physical health Injury (e.g., upper extremities) • • Financial loss Societal Costs • Hospitalization • Nursing home placement • Emergency room use • Social service, legal, and law enforcement
Strong EM Risk Factors Victim Trusted Other Functional Impairment Mental Illness Poor Physical Health Substance Abuse Cognitive Impairment Dependency (financial) Poor Mental Health Low Income Lower Age Low Social Support Pillemer, Burnes, Riffin, & Lachs (2015)
International 1-Year Prevalence by EM Type Pillemer, Burnes, Riffin, & Lachs (2015)
Canada/US 1-Year Prevalence by EM Type 9.5 10 9 8 7 6 4.8 5 4.1 3.9 4 Series 1 3 1.7 2 0.5 1 0 (Acierno et al., 2011; Amstadter et al., 2011; Burnes et al., 2015)
1-Year Prevalence Approximately 1 out of every 10 adults aged 60 or older experiences some form of EM each year • 475,000, Canada • 190,000, Ontario Under-estimated prevalence : Under-reporting among elders • • Excludes cognitive impairment • Excludes older adults in institutional settings
Hidden Problem The majority of EM victims remain hidden and never interface with formal support • USA - Acierno et al. (2010): 1 out of every 6 (18%) • NYS - Lachs and Berman (2011): 1 out of 24 (4%) • SC - Amstadter et al. (2011): 1 out of every 8 (13%) • Boston - Pillemer & Finkelhor: 1 out of 14 (7%) Only 4% to 18% of victims seek formal support
Prevalence Studies EM measured as a dichotomous outcome NO YES
Prevalence Studies NO YES YES
Frequency/Multiplicity of Elder Mistreatment Past Year 140 35 35 30 30 120 25 25 100 Frequency Frequency 20 20 80 15 15 60 10 10 40 5 5 20 0 0 0 0 2 6 12 18 25 36 0 2 12 16 19 24 42 63 0 2 7 15 18 21 24 30 36 42 Frequency/Multiplicity Frequency/Multiplicity Frequency/Multiplicity Neglect Emotional Abuse Physical Abuse N = 399 N = 51 N = 89 Mean: 2 to 10 Mean: 1 to 2 events Mean: 2 to 10 events per year per year events per year Burnes, Pillemer, & Lachs, 2015
Mistreatment Severity Correlates Emotional Physical Neglect Younger Age Younger Age Younger Age Living Alone w Living Alone w Living Alone w Perpetrator Perpetrator Perpetrator Higher Lower Education Education Hispanic Lower Income Functional Impairment
Alone with Perpetrator Shared Living Severity Arrangement Presence of Non- Perpetrators
Victim Appraisals of Mistreatment 45 45 45 Emotional Abuse Physical Abuse Neglect 40 40 40 N = 106 N = 51 N = 66 35 35 35 30 30 30 25 25 25 20 20 20 15 15 15 10 10 10 5 5 5 0 0 0 Not Serious Somewhat Very Serious Not Serious Somewhat Very Serious Not Serious Somewhat Very Serious Serious Serious Serious Distribution of perceived seriousness levels among victims of emotional abuse, physical abuse and neglect Burnes, Lachs, Burnette, & Pillemer, 2016
EM in Institutional Long-Term Care (LTC) Settings
Elder Mistreatment in LTCs EM is the most common type of complaint made to LTC regulatory authorities
Chronology and Intensity of Public and Academic Interest of Interpersonal Violence in LTC Settings Staff Resident Resident Staff Resident Resident
Staff-to-Resident • Approximately 10% of LTC staff self-report physically abusive acts towards residents Excessive restraint Pushing, grabbing, pinching Hitting, slapping • Approximately 40% of LTC staff self-report psychologically abusive acts towards residents Yelling, insulting, swearing Denying food or privileges as punishment
Staff-to-Resident Risk Factors Characteristics of staff who are more likely to mistreat residents: Poor job satisfaction (frequently thinks about quitting) Tend to view residents as child-like High sense of burn-out Stressful personal life
Resident-to-Resident Aggression Negative, aggressive and intrusive verbal, physical, sexual, and material interactions between long- term care residents that in a community setting would likely be unwelcome and potentially cause physical or psychological distress or harm to the recipient (Pillemer et al., 2012; McDonald et al., 2015)
What Do We Know About RRA? Approximately 20% of LTC residents experience some form of RRA Most common forms of RRA • Verbal (e.g., screaming, cursing) – 9.1%% • Physical (e.g., hitting, pushing) – 5.2% • Sexual (e.g., inappropriate touching) – 0.6% • Other (property damage, privacy invasion) – 5.3% Most common areas in LTC: • Resident rooms – 37% • Dinning room – 37% • Activity/common area – 24% (Lachs et al., 2016)
Consequences of RRA? Physical injury • Lacerations, bruising, fractures (Shinoda-Tagawa et al., 2004) Poor psychosocial status • Depression, anxiety, social loneliness, low self- esteem, low life satisfaction, unpleasant living environment (Castle, 2012; Trompetter et al., 2011) Canadian LTC residents perceive RRA as a normal part of nursing home life (Lapuk, 2007) Chronic stress and potential trauma have cumulative, detrimental long-term effects on health and quality of life (Friedman & McEwen, 2004)
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